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Short-term health plans are can be sold in Arizona with terms of up to 364 days and total duration, including renewals, of up to three years. This is a rule change that took effect in August 2019 in the state, following implementation of a new state law.

Arizona has expanded Medicaid, but has obtained federal approval for a Medicaid work requirement. The state has delayed implementation of the work requirement, however, amid ongoing legal challenges across the country.

Arizona’s health insurance marketplace

Arizona uses the federally facilitated exchange, so residents enroll through HealthCare.gov. Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.

Arizona made headlines in the fall of 2016, due to the number of insurers leaving the exchange and the significant rate increases for 2017. But for 2018, Arizona had among the smallest rate increases in the country, with rates virtually unchanged from 2017.

For 2020, Arizona’s exchange participation jumped to five insurers, up from just two in 2018.

Enrollment in QHPs through the Arizona exchange has dropped by 25% since 2016

During 2016 open enrollment, 203,066 people enrolled in private health plans through Arizona’s exchange. Enrollment has declined each year since then, and only 153,020 people signed up for private individual market plans through Arizona’s exchange during the open enrollment period for 2020 coverage. That’s nearly a 25 percent reduction in enrollment in four years.

Medicaid in Arizona

Former Gov. Brewer followed a different course than most Republican governors and pushed hard for Medicaid expansion in Arizona. A bill authorizing expansion was passed with some Republican support and signed into law by Brewer in 2013.

However, the expansion has been repeatedly challenged. The Arizona legislature in February 2015 passed SB1092, which requires the state to seek an annual waiver from CMS to allow additional eligibility restrictions for Arizona’s Medicaid program – Arizona Health Care Cost Containment System (AHCCCS, which is pronounced “access”). Gov. Ducey signed the bill into law in March 2015.

In September 2016, the Obama Administration CMS approved Arizona’s waiver proposal, but eliminated the most conservative aspects of it. The new waiver runs through September 2021. It implemented a requirement for modest health savings account contributions from enrollees with income above the poverty level, and enrollment in an optional (rather than mandatory) job search program.

Under the Obama Administration, CMS did not allow Arizona to implement a work requirement, limit AHCCCS coverage for able-bodied adults to five years, or to charge premiums for people with income below the poverty level. The state also cannot lock people out of AHCCCS for six months if they miss a health savings account contribution, or charge fees for missed health care appointments.

Arizona saw a 45 percent increase in monthly Medicaid/CHIP enrollment from 2013 to November 2016. But enrollment plateaued by 2016 (as was the case in most states), and net enrollment was up 43 percent as of late 2019 — slightly lower than it had been two years earlier. Nationally, Medicaid enrollment is up about 26 percent from where it was in 2013.

Short-term health insurance in Arizona

Arizona changed its rules for short-term health plans in 2019, allowing them to follow federal rules instead of the stricter rules the state had previously imposed. So short-term plans in Arizona can have initial terms of up to 364 days, and total duration, including renewals, of up to three years.

How has Obamacare helped Arizona’s uninsured?

According to U.S. Census data, 17.1 percent of Arizona residents were uninsured in 2013, and that had dropped to 10.1 percent by 2017, although it crept back up to 10.6 percent by 2018. Nationwide there has been a gradual increase in the uninsured rate under the Trump Administration.

While Arizona’s uninsured rate improved with Obamacare in effect, it’s still above the national average (8.9 percent in 2018).

In the 2010 election, Arizona voters approved a state constitutional amendment barring any state rules or regulations that would force state residents to participate in a healthcare system. Federal law supersedes state law, so the ACA’s individual mandate still applies in Arizona, although the penalty for non-compliance was repealed as of 2019.

Despite opposing the ACA in general, former Governor Jan Brewer was in favor of state-run health insurance exchange and said it was preferable to a one-size-fits-all model imposed by the federal government. To that end, Brewer established the Office of Health Insurance Exchange, and the state took numerous steps toward setting up a state-run exchange. However, state legislators and a public majority remaining opposed. Brewer ultimately bowed to public sentiment and defaulted to the federally facilitated marketplace.

Doug Ducey, a Republican, took over the governor’s office in January 2015, and won re-election in 2018. During his campaign, he described himself as “100 percent opposed to Obamacare.” Within months of taking office, he signed House Bill 2643 into law, effectively banning the state from creating a state-run exchange. So Arizona, like most states, continues to use HealthCare.gov.

Arizona health insurance resources

Arizona health reform legislation

Gov. Ducey signed HB2643 into law in April 2015. The legislation effectively bans the state from creating a state-run exchange.

Also in 2015, SB1092 was signed into law, requiring the state to continue to ask CMS to approve eligibility changes for Medicaid, including a work requirement and a five-year lifetime coverage limit. The Obama Administration rejected most of the major changes that the state wanted to make, but a new waiver proposal, submitted in late 2017, gained partial approval from the Trump administration.

Scroll to the bottom of this page for a round-up of other healthcare reform legislation at the state level in Arizona.